Pediatric Cardiology

, 30:311 | Cite as

Autonomic Nervous System Function in Infants and Adolescents: Impact of Autonomic Tests on Heart Rate Variability

  • Elke Longin
  • Carmen Dimitriadis
  • Samina Shazi
  • Thorsten Gerstner
  • Tamara Lenz
  • Stephan König
Original Article

Abstract

Measurement of heart rate variability (HRV) shows information on the functional state of the autonomic nervous system (ANS). In adults there are standardized autonomic tests and well-established ranges of normal values, which is not the case in children. The aim of the present study was (1) to introduce an ANS test battery, especially for children and adolescents; (2) to establish normative HRV parameters; and (3) to determine the impact of ANS tests on HRV parameters compared with baseline measurements. We investigated 100 healthy children and adolescents between 6 and 15 years old. We subdivided the investigated group into a group of children (5–11 years old) and adolescents (12–15 years old) and measured HRV by time and frequency domain parameters during baseline, rhythmic breathing, Valsalva test, active standing, tilt-table testing, and handgrip test. The normative HRV data are presented by means, SDs, medians, and percentiles. The results described refer to baseline values for each HRV parameter separately to demonstrate the influence of age on HRV parameters. The study results present not only first normative HRV data for an autonomic test battery especially adapted to children and adolescents, but they also quantify the autonomic changes induced by test procedures compared with baseline measurements.

Keywords

Autonomic test Children Heart rate variability Normative data 

Notes

Acknowledgments

This study was supported by the Dietmar-Hopp-Stiftung, SAP, Walldorf, Germany.

References

  1. 1.
    Baldzer K, Dykes FD, Jones SA, Brogan M, Carrigan TA, Giddens DP (1989) Heart rate variability analysis in full-term children: spectral indices for study of neonatal cardiorespiratory control. Pediatr Res 26:188–195PubMedCrossRefGoogle Scholar
  2. 2.
    Berger RD, Akselrod S, Gordon D, Cohen RJ (1986) An efficient algorithm for spectral analysis of heart rate variability. IEEE Trans Biomed Eng 33:900–904PubMedCrossRefGoogle Scholar
  3. 3.
    Bernardi L, Salvucci F, Leuzzi S, Radaelli A, Calciati A, Valle F et al (1996) Cardiovascular reflex changes preceding episodes of vasovagal syncope in paediatric subjects. Clin Sci 91:25–27PubMedGoogle Scholar
  4. 4.
    Bigger JT, Fleiss JL, Steinmann RC, Rolnitzky LM, Kleiger RE, Rottmann JN (1992) Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85:164–171PubMedGoogle Scholar
  5. 5.
    Chatow U, Davidson S, Reichman BL, Akselrod S (1995) Development and maturation of the autonomic nervous system in premature and full-term children using spectral analysis of heart rate fluctuation. Pediatr Res 37:294–303PubMedCrossRefGoogle Scholar
  6. 6.
    Dettmers C, Faust H, Fatepour D, Tackmann W (1974) Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function. Clin Sci Mol Med 46:295–306Google Scholar
  7. 7.
    Dettmers C, Faust H, Fatepour D, Tackmann W (1993) Sympathetic skin response―Physiological principles, normal values and clinical use. Fortschr Neurol Psychiatr 61:369–77PubMedCrossRefGoogle Scholar
  8. 8.
    Edner A, Katz-Salamon M, Lagercrantz H, Ericson M, Milerad J (2000) Heart rate variability in children with apparent life-threatening events. Acta Paediatr 89:1326–1329PubMedCrossRefGoogle Scholar
  9. 9.
    Eiris-Punal J, Rodriguez-Nunez A, Fernandez-Martinez N, Fuster M, Castro-Gago M, Martinon JM (2001) Usefulness of head-upright tilt test for distinguishing syncope and epilepsy in children. Epilepsia 42:709–13PubMedCrossRefGoogle Scholar
  10. 10.
    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 285(6346):916–918CrossRefGoogle Scholar
  11. 11.
    Ewing DJ, Campbell IW, Clarke BF (1980) The natural history of diabetic autonomic neuropathy. Q J Med 49(193):95–108PubMedGoogle Scholar
  12. 12.
    Ewing DJ, Martyn CN, Young RJ, Clarke BF (1985) The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 8:491–8PubMedCrossRefGoogle Scholar
  13. 13.
    Freeman R, Saul JP, Roberts MS, Berger RD, Broadbridge C, Cohen RJ (1991) Spectral analysis of heart rate in diabetic neuropathy. Arch Neurol 48:185–190PubMedGoogle Scholar
  14. 14.
    Giddens DP, Kitney RI (1985) Neonatal heart rate variability and its relation to respiration. J Theor Biol 113:759–780PubMedCrossRefGoogle Scholar
  15. 15.
    Goto M, Nagashima M, Baba R, Nagano Y, Yokota M, Nishibata K et al (1997) Analysis of heart rate variability demonstrates effects of development on vagal modulation of heart rate in healthy children. J Pediatr 130:725–729PubMedCrossRefGoogle Scholar
  16. 16.
    Hyndman BW, Kitney RI, Sayers BM (1971) Spontaneous rhythms in physiological control systems. Nature 233(5318):339–341PubMedCrossRefGoogle Scholar
  17. 17.
    Kaplan DT (1994) The analysis of variability. J Cardiovasc Electrophysiol 5:16–19PubMedCrossRefGoogle Scholar
  18. 18.
    Kleiger RE, Miller JB, Bigger JT, Moss AJ (1987) Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59:256–262PubMedCrossRefGoogle Scholar
  19. 19.
    Malik M, Camm AJ (1993) Components of heart rate variability―What they really mean and what we really measure. Am J Cardiol 72:821–822PubMedCrossRefGoogle Scholar
  20. 20.
    Malik M, Farell T, Cripps T, Camm AJ (1989) Heart rate variability in relation to prognosis after myocardial infarction: selection of optimal processing techniques. Eur Heart J 10:1060–1074PubMedGoogle Scholar
  21. 21.
    Massin M, von Bermuth G (1998) Clinical and heamodynamic correlates of heart rate variability in children with congenital heart disease. Eur J Pediatr 157:967–971PubMedCrossRefGoogle Scholar
  22. 22.
    Massin M, von Bernuth G (1997) Normal ranges of heart rate variability during infancy and childhood. Pediatr Cardiol 18:297–302PubMedCrossRefGoogle Scholar
  23. 23.
    Massin M, Henrad V, Gerard P (2000) Heart rate variability and the outcome of head-up tilt in syncopal children. Acta Cardiol 55:163–168PubMedCrossRefGoogle Scholar
  24. 24.
    Merri M, Farden DC, Mottley JG, Titlebaum EL (1990) Sampling frequency of the electrocardiogram for the spectral analysis of heart rate variability. IEEE Trans Biomed Eng 37:99–106PubMedCrossRefGoogle Scholar
  25. 25.
    Pagani M, Malfatto G, Pierini S, Casati R, Masu AM, Poli M et al (1988) Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy. J Auton Nerv Syst 23:143–153PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenstock EG, Cassuto J, Zmora E (1999) Heart rate variability in the neonate and infant: analytical methods, physiological and clinical observations. Acta Paediatr 88:477–82PubMedCrossRefGoogle Scholar
  27. 27.
    Rudiger H, Klinghammer L, Scheuch K (1999) The trigonometric regressive spectral analysis—A method for mapping of beat-to-beat recorded cardiovascular parameters on to frequency domain in comparison with Fourier transformation. Comput Methods Programs Biomed 58:1–15PubMedCrossRefGoogle Scholar
  28. 28.
    Scaramuzza A, Salvucci F, Leuzzi S, Radaelli A, d’Annunzio G, Fratino P et al (1998) Cardiovascular autonomic testing in adolescents with type I (insulin-dependent) diabetes mellitus: an 18 month follow up study. Clin Sci 94:615–621PubMedGoogle Scholar
  29. 29.
    Schechtman VL, Raetz SL, Harper RK, Garfinkel A, Wilson AJ, Southall DP et al (1992) Dynamic analysis of cardiac RR-intervals in normal children and in children who subsequently succumbed to the sudden infant death syndrome. Pediatr Res 31:606–612PubMedCrossRefGoogle Scholar
  30. 30.
    Schechtman VL, Harper RK, Harper RM (1993) Analysis of beat-to-beat heart rate changes during sleep-waking states in normal infants. J Dev Physiol 19:263–71PubMedGoogle Scholar
  31. 31.
    Schechtmann VL, Kluge KA, Harper RM (1988) Time-domain system for assessing variation in heart rate. Med Biol Eng Comput 26:367–373CrossRefGoogle Scholar
  32. 32.
    Scherer P, Ohler JP, Hirche H, Höpp HW (1993) Definition of a new beat-to-beat parameter of heart rate variability. Pacing Clin Electrophysiol 16:939Google Scholar
  33. 33.
    Silvetti MS, Drago F, Ragonese P (2001) Heart rate variability in healthy children and adolescents is partially related to age and gender. Int J Cardiol 81:169–174PubMedCrossRefGoogle Scholar
  34. 34.
    Steward JM, Erb M, Sorbera C (1996) Heart rate variability and the outcome of head-up tilt in syncopal children. Pediatr Res 40:702–709CrossRefGoogle Scholar
  35. 35.
    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043–1065Google Scholar
  36. 36.
    Verotti A, Chiarelli F, Morgese G (1996) Autonomic dysfunction in newly diagnosed insulin-dependent diabetes mellitus children. Pediatr Neurol 14:49–52CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Elke Longin
    • 1
    • 2
  • Carmen Dimitriadis
    • 1
  • Samina Shazi
    • 1
  • Thorsten Gerstner
    • 1
  • Tamara Lenz
    • 3
  • Stephan König
    • 1
  1. 1.Children’s HospitalUniversity of MannheimMannheimGermany
  2. 2.Children’s DepartmentHospital VendsysselHjoerringDenmark
  3. 3.Statistical ConsultingMannheimGermany

Personalised recommendations